Maternal Medicine Extra Quesions Batch A – MCQ

1. Clinical signs suggestive of sepsis include all of the following except:

A. Hypothermia
B. Polyuria
C. Pyrexia
D. Tachycardia
E. Tachypnoea

2. What is false about immunisation and antibiotic prophylaxis in women at risk of transfusion related infections?

A. All women who have undergone a splenectomy should take penicillin prophylaxis or equivalent.
B. All women who have undergone a splenectomy should be vaccinated for pneumococcus and. Haemophilus influenzae type B if this has not been done before.
C. Hepatitis B vaccination is recommended in HBsAg-positive women who are transfused or may be transfused.
D. Hepatitis C status should be determined.
E. The pneumococcal vaccine should be given every 5 years.

3. The pneumococcal vaccine should be given every 5 years.

A. Disseminated intravascular coagulation
B. Elevated liver enzymes
C. Hypoglycaemia
D. Hyperuricaemia
E. Proteinuria

4. Of the following symptoms, mark the one ‘not’ included in the classical symptomatology of Wernicke’s encephalopathy:

A. Ataxia
B. Blindness
C. Confusion
D. Convulsions
E. Nystagmus

5. The following are known complications of obstetric cholestasis in pregnancy except:

A. Intrauterine deaths
B. Maternal pruritus
C. Meconium staining of liquor
D. Neonatal jaundice
E. Preterm birth

6. All the following are category C drugs in pregnancy except:

A. Aspirin
B. Cyclophosphamide
C. Hydroxychloroquine
D. Sulphasalazine
E. Tacrolimus

7. All of the following statements about the thyroid hormones in pregnancy are true except:

A. Free T3 level is unchanged.
B. Increased thyroid binding globulin in blood.
C. Total T3 and T4 levels are increased.
D. TSH rises in the third trimester.
E. T3 crosses the placental barrier.

8. Of the following statements about hyperthyroidism in pregnancy, select the correct one:

A. During pregnancy, treatment should be aimed at keeping the thyroid hormones at the lower limit of normal range.
B. Fetal hypothyroidism is a common complication in these patients.
C. Pregnancy worsens thyroid status especially in the third trimester
D. Propylthiouracil and carbimazole can be safely continued in pregnancy.
E. Propylthiouracil and carbimazole do not cross the placenta.

9. Hypopituitarism presents with all of these features except:

A. Adrenocortical insufficiency
B. Amenorrhoea
C. Anosmia
D. Failure to lactate
E. Hypothyroidism

10. Hyperprolactinemia can be caused by all of the following except:

A. Dopamine antagonists
B. Hyperthyroidism
C. Pituitary adenomas
D. Polycystic ovarian disease
E. Pregnancy

11. All of the following are true regarding carbohydrate metabolism in pregnancy except:

A. Decrease in insulin sensitivity in early pregnancy.
B. Fasting blood sugars are 10–20 % lower.
C. Hyperplasia of islets of Langerhans.
D. Increase in free fatty acids and ketones bodies in circulation.
E. Insulin resistance increases as pregnancy advances.

12. The target range for blood sugars during labour for a pregnancy complicated by pre- existing diabetes is:

A. 2–4 mmol/L
B. 4–6 mmol/L
C. 6–8 mmol/L
D. 8–10 mmol/L
E. 10–12 mmol/L

13. The following statement is true regarding metformin use in pregnancy:

A. It has no reported adverse fetal outcomes.
B. It is licensed for use during pregnancy.
C. It is effective in achieving good glycaemic control in pregnancy.
D. It is classified as a category C drug.
E. Lactic acidosis is a common complication.

14. In GDM, maternal hyperglycaemia is independently and significantly linked to all of the following adverse outcomes except:

A. Caesarean delivery
B. Early miscarriages
C. Fetal hyperinsulinism
D. Macrosomia
E. Neonatal hypoglycaemia

15. All of the following are pre-existing risk factors for development of type 2 diabetes except:

A. Assisted reproduction
B. Increasing parity
C. Maternal age
D. Maternal BMI
E. Twin pregnancy

16. Increase in the risk of pulmonary thromboembolism in women with BMI >30 is:

A. Same as women with BMI <30
B. 3–5 times increased
C. 5–10 times increased
D. 10–12 times increased
E. 15 times increased

17. Which of the following statements best describes the role of serum ferritin in pregnancy?

A. An unstable glycoprotein involved in iron transport.
B. An acute phase reactant and levels rise in infection.
C. Best test parameter to assess any type of anaemia in pregnancy.
D. Ferritin levels steadily reduce as pregnancy progresses.
E. Treatment should be started when ferritin levels are below 50 μg/l.

18. The risk of recurrent urinary tract Infection in pregnancy is:

A. 1–2%
B. 4–5%
C. 10–15 %
D. 15–18 %
E. 20%

19. A 30-year-old woman, who is 36 weeks pregnant, is seen in antenatal clinic. This is her first pregnancy. She is HIV positive. She has been fully compliant with her HAART (highly active antiretroviral therapy) throughout her pregnancy. Her latest serum viral load is <50 copies/mL. Apart from HIV, her pregnancy has been uncomplicated, and she has an appropriately grown cephalic presentation fetus. She is concerned about vertical transmission of HIV and is keen to avoid surgery if possible. Which one of the following is recommended management and advice?

A. Elective caesarean at 38 weeks gestation.
B. Elective caesarean at 39 weeks station.
C. Induce vaginal birth at 38 weeks gestation.
D. Offer spontaneous vaginal birth.
E. Postnatally, breastfeeding is considered safe as viral copy number is low.

20. A 38-year-old woman is 12 weeks pregnant with a twin pregnancy. This is her second pregnancy, with her previous pregnancy complicated by gestational hypertension. Her booking blood pressure, at 12 weeks, is 135/85 mmHg. Her BMI is 34 kg/m2. She smokes 10 cigarettes/day. Which one of the following is considered a significant (high) risk factor for the development of pre-eclampsia as her pregnancy progresses?

A. Age >35
B. BMI >30
C. Hypertensive disease during previous pregnancy
D. Multiple pregnancy
E. Smoking

21. A 28-year-old woman is 12 weeks pregnant with a singleton pregnancy. This is her first pregnancy. Her booking blood pressure, at 12 weeks, is 140/90 mmHg. Her BMI is 34 kg/m . She smokes 10 cigarettes/day. Her mother suffered from pre-eclampsia in her pregnancies. Which one of the following is considered a significant (high) risk factor for the development of pre-eclampsia as her pregnancy progresses?

A. BMI >30
B. Elevated blood pressure at pregnancy booking
C. First pregnancy
D. Family history of pre-eclampsia
E. Smoking

22. A 35-year-old woman is 33 weeks pregnant in first pregnancy. She has a one day history of headache and blurred vision. Her blood pressure is 180/110 mmHg. Urinalysis shows +++ protein. One week prior, her blood pressure was 120/70 mmHg and she had no proteinuria. Of the options listed below, select the most appropriate INITIAL drug to administer:

A. Intramuscular betamethasone
B. Intravenous magnesium sulphate
C. Intravenous furosemide
D. Intravenous diazepam
E. Oral methyldopa

23. A 30-year-old woman is 16 weeks pregnant in her third pregnancy. Her blood pressure is 155/105 mmHg; 4 weeks earlier, it was 150/100 mmHg. Her urinalysis shows + protein. Her spot urinary protein/creatinine ratio is 35 mg/mmol, and a 24-h urine collection result shows 0.35 g protein. Which one of the following is considered the most likely diagnosis?

A. Chronic hypertension
B. Chronic hypertension and superimposed pre-eclampsia
C. Gestational hypertension
D. Nephrotic syndrome
E. Pre-eclampsia

24. Which of the following conditions is not a known complication of maternal chicken pox in pregnancy?

A. Cholecystitis
B. Death
C. Encephalitis
D. Hepatitis
E. Pneumonitis

25. Regarding pregnancy outcome after bariatric surgery in obese reproductive age women, which of the following is true?

A. Pregnancy should be delayed for at least 2 years following bariatric surgery.
B. Dumping syndrome following bariatric surgery can be provoked by 75 g GTT.
C. Ideal gestational weight gain (GWG) for pregnancies following bariatric surgery is 8–10 k.g.
D. Pregnant women need not take supplements of folic acid, vitamin B12 and iron.
E. There is increased risk of preterm deliveries and congenital anomalies.

26. Which of the following statements is incorrect regarding asthma in pregnancy?

A. Asthma does not usually affect labour or delivery.
B. Asthma is a common condition that affects about 10 % of pregnant women.
C. Asthma worsens in pregnancy in 80 % of the cases.
D. Inhaled corticosteroids are the standard anti-inflammatory therapy for asthma.
E. In the postpartum period, there is not an increased risk of asthma exacerbations.

27. Ms XY has is a primigravida, 29 weeks pregnant and has been diagnosed with gestational diabetes on her 2 h OGTT. Her fasting plasma glucose on the OGTT was 7.3 mmol/L. Which of the following treatment options are best suited to her?

A. Dietary modification alone
B. Insulin+diet+exercise
C. Metformin+diet+exercise
D. Glibenclamide+diet+exercise

28. Ms XY is 38-year-old G5P4 with a BMI of 32. She presents to the consultant-led ANC at 28 weeks with a fetal growth scan, which is normal. She is otherwise fit and well. She takes routine pregnancy supplements. In terms of VTE prophylaxis, which of the following is best suited to her?

A. LMWH from 28 weeks+postpartum LMWH for 10 days
B. LMWH from 28 weeks + postpartum LMWH for 6 weeks
C. No VTE prophylaxis
D. Postpartum LMWH for 10 days
E. TEDS in the antenatal period

29. Ms XY is a primigravida, 32 weeks pregnant. She was diagnosed to have GDM on her 28-week OGTT. So far she has tried diet, exercise and metformin therapy. Her plasma glucose values are still not within target ranges for pregnancy. She declines insulin therapy, as she is needle phobic.

A. Alpha-glucosidase inhibitors
B. Incretin-based treatments
C. SGLT-2 inhibitors
D. Sulphonylureas
E. Thiazolidinediones

30. Ms XY is a Para 1 who delivered 13 weeks ago. She was diagnosed to have GDM (diet controlled). Her recent fasting plasma glucose level is 6.3 mmol/L and her HbA1C is 6 %. What is her risk of developing type 2 diabetes?

A. Current type 2 diabetes
B. High risk of developing type 2 diabetes
C. Moderate risk of developing type 2 diabetes
D. NO risk of developing type 2 diabetes
E. Low risk of developing type 2 diabetes

31. Pregnant women with epilepsy have the highest risk of breakthrough seizures during:

A. First trimester
B. Intrapartum
C. Postpartum
D. Second trimester
E. Third trimester

32. In cases of pheochromocytoma in pregnancy, which of the following is true?

A. Hypertension is seen in most cases.
B. Less than 1 % cases are familial.
C. More than 50 % cases are bilateral.
D. Patient should be started on alpha- and beta-adrenergic blockers immediately post diagnosis.
E. Surgery offers best cure in pregnancy.

33. What percentage of pregnancies are complicated by hypertensive disorders?

A. 1–2%
B. 1–6%
C. 2%
D. 2–8%
E. 10–12 %

34. Ms XY is a primigravida who is 30 weeks pregnant. She presents to A + E with acute onset of shortness of breath and chest pain. She has just travelled via a long haul flight (12 h) to the UK. She has been commenced on therapeutic LMWH (dalteparin) pending investigations to rule out a PE. Her booking weight is 66 kg and she currently weighs 76 kg. What is the correct dose of dalteparin she should receive?

A. 5000 IU once daily
B. 8000 IU twice daily
C. 10,000 IU once daily
D. 12,000 IU twice daily
E. 16,000 IU once daily

35. A 42-year-old primigravida at 32 weeks of gestation complains of sudden onset acute pain in her chest on the left side radiating to the shoulder and arm. She has vomiting, epigastric pain and dizziness. Which of the following tests would be part of the first-line investigations in her case?

A. Angiography of pulmonary arteries
B. Echocardiography
C. Electrocardiography
D. Troponin T levels
E. Ultrasound of the abdomen

36. In pregnant patients with prolactinomas:

A. Bromocriptine must be continued in pregnancy for all cases.
B. Cabergoline is the drug of choice during lactation.
C. MRI and prolactin levels should be done in each trimester as surveillance for patients with macroprolactinoma.
D. Patient presents with headache and visual disturbances on exacerbation.
E. Surgery can be safely performed and is the treatment of choice during pregnancy.

37. Which of the following statements is false regarding hepatitis C infection in pregnancy?

A. Acute hepatitis C is a rare event in pregnancy, and the most common scenario is chronic hepatitis C virus (HCV) infection in pregnancy.
B. Coinfection with human immunodeficiency virus (HIV) increases the rate of mother-to-child transmission up to 19.4 %.
C. High viral load defined as at least 2.5 × 106 viral DNA copies/mL.
D. Interferon is contraindicated for treatment in pregnancy.
E. The overall rate of mother-to-child transmission for HCV is 3–5 % if the mother is known to be anti-HCV positive.

38. Ms XY is a primigravida who is 30 weeks pregnant. She presents to A + E with acute onset of shortness of breath and chest pain. She has just travelled via a long haul flight (12 h) to the UK.

Which of the following investigations is not appropriate in the investigation of a suspected pulmonary embolus in pregnancy?

A. CTPA
B. CXR
C. D-Dimer
D. ECG
E. V/Q Scan

39. Ms XY is a primigravida who is 32/40 weeks pregnant. She visits a friend over the weekend who informs her 5 days later that she has had shingles during their visit. Ms XY is unclear about her history of chickenpox and has recently travelled to the UK from the tropics. Which of the following treatment options are best suited to her?

A. Acyclovir.
B. Administration of varicella vaccine (live attenuated).
C. Blood test for varicella zoster immunity.
D. Immediate administration of VZIG.
E. Reassurance as shingles is rather non-infective.

40. In case of maternal death due to sepsis, the postmortem protocol includes blood culture obtained from a blood sample immediately after death before opening the body. Which of the following should not be used for such sampling?

A. Brachial vein
B. Direct cardiac blood sampling
C. Femoral vein
D. Jugular vein
E. Spleen parenchyma

41. Which of the following statements is true regarding pituitary insufficiency?

A. Average delay from onset to diagnosis is 7 months.
B. Failure to lactate occurs in almost all cases.
C. It is prudent to replace glucocorticoid and thyroxine in these patients during pregnancy.
D. Patients post Sheehan’s syndrome/pituitary apoplexy rarely get pregnant.
E. The occurrence of Sheehan’s syndrome is proportional to the amount of PPH.

42. You are attending to Mrs X in the antenatal clinic. She is a 24-year-old primigravida in her ninth week of pregnancy. She is concerned about an increase in the nausea and vomiting tendency over the last week and has come to seek advice from you in this regard. You would be wrong if you told her:

A. About 30 % of pregnant women may be affected by severe nausea and vomiting, and it can cause significant morbidity.
B. In some women, the condition is so intolerable that they actually elect to have a termination of the current pregnancy
C. It is appropriately called ‘morning sickness’ as symptoms are severe in the morning and subside by midday.
D. Over25,000admissionsoccurperyearforhyperemesisgravidaruminEngland.
E. Safe, effective treatments for severe nausea and vomiting of pregnancy are available.

43. A 26-year-old primigravida, 26 weeks gestation has chronic hepatitis B infection. She is on Tenofovir for treatment of the HBV infection. She is HbeAg negative and the viral load is 104 IU/ml.

Which of the following statements is true regarding her medical condition?

A. Both passive and active immunisation are warranted to prevent perinatal transmission.
B. Interferon therapy if possible is the treatment of choice in pregnancy.
C. Tenofovir should be immediately stopped.
D. The risk of perinatal transmission in her case is more than 20 %.
E. There is high chance of immunisation failure due to her viral load.

44. Which of the following is true regarding Cushing’s syndrome in pregnancy?

A. Distal myopathy is a distinguishing feature from signs and symptoms of pregnancy.
B. Diurnal variation of cortisol is lost in all cases.
C. More commonly due to pituitary adenomas than adrenal adenomas.
D. MRI of adrenals should always be done to rule out carcinoma.
E. Preferred screening test is imaging of adrenals, i.e., USG/MRI.

45. Ms XY is a Para 1, 6 weeks postpartum. She was delivered at 27 weeks as she developed severe pre-eclampsia and HELLP syndrome. She is doing well and so is her son in special care. She is seeing a consultant today for a postnatal debrief. She is very anxious that she may develop pre-eclampsia again in the subsequent pregnancy. What is the risk of recurrence of pre-eclampsia in her subsequent pregnancy?

A. 15%
B. 25%
C. 35%
D. 45%
E. 55%

46. Ms XY is 38 + 3/40 weeks pregnant. She has a booked induction for GDM at 39/40 weeks. She has a confirmed diagnosis of chickenpox and is presently on acyclovir. Which of the following treatment options are best suited to her?

A. Caesarean section on the planned date
B. Delay delivery at least by 7 days
C. Immediate delivery by caesarean section to prevent neonatal transmission
D. Immediate induction to prevent worsening infection
E. Induction of labour on the planned date

47. A 20-year-old primigravida with 30 weeks gestation has presented in the casualty with preterm labour pains. She has history of productive cough and fever since 15 days. She has a BMI of 19 and was diagnosed with gestational diabetes at 20 weeks. She has had a poor gestational weight gain. It is true to say that in this condition:

A. About 5 % of women have pre-existing or gestational diabetes.
B. FEV1 < 80 % is an absolute contraindication to pregnancy.
C. If the partner does not carry the mutation, then risk of having affected child is around 1:250.
D. Premature delivery is seen in more than half of pregnancies.
E. Women are usually infertile.

48. Ms XY (para 1) is 8/52 postnatal. She was diagnosed with obstetric cholestasis in her pregnancy. Her recent LFTS are within normal limits. She is concerned about this risk of recurrence of this condition as she required an induction this time and would like a spontaneous birth in her subsequent pregnancy.

A. 1–5%
B. 5–10 %
C. 10–20 %
D. 20–40 %
E. 45–90 %

49. It is important to optimise pre-pregnancy health in a woman with sickle cell disease. You have advised many blood tests and systemic evaluations to a 29-year-old woman with sickle cell disease to help determine her pre-pregnancy health status. She is asking you for a clarification regarding the exact ‘eye test’ you have advised. It is most likely to be:

A. Cataract screening
B. Corneal opacity screening
C. Glaucoma screening
D. Retinal screening
E. Visual acuity screening

50. All of the following statements about thalassemia syndromes are true except:

A. Are a common variety of inherited disorders.
B. The basic defect is reduced globin chain synthesis.
C. Beta-thalassemia leads to a mineral deficiency anaemia.
D. Beta-thalassemia in heterozygous state can cause mild to moderate anaemia with no significant detrimental effect on overall health
E. Thalassemia intermedia is a group of patients with beta-thalassemia whose disease severity varies.

Maternal Medicine Extra Quesions Batch A – MCQ

Maternal Medicine Extra Quesions Batch A – MCQ

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